Mindfulness-Based Intervention Significantly Reduces Psychotic Symptoms

A recent study demonstrated that mindfulness-based intervention provides significantly moderate effects to reduce psychotic symptoms and increase global functioning, insight, and mindfulness in individuals with schizophrenia.¹ The findings support mindfulness-based intervention as a complementary treatment for schizophrenia.

Antipsychotic medicine and electroconvulsive therapy (ECT), although effective for treating schizophrenia spectrum disorders, may lead to adverse events of acute dystonia, akathisia parkinsonism, tardive dyskinesia, weight gain, sexual dysfunction, sleep problems, and metabolic complications such as diabetes and hyperlipidemia. These treatments often harm cognition and memory when used long-term.

A weakened cognition puts individuals with schizophrenia at risk of hospitalization. A meta-analysis published earlier this year discovered that patients with schizophrenia and moderate or severe cognitive impairment had a 100% increase in relapse-related hospitalization (0.6 vs 0.3; adjusted incidence rate ratio [aIRR], 1.85; P < .05) and ER visits (0.4 vs 0.2; aIRR, 1.77; P < .05), compared with patients who experienced no or mild cognitive impairment.²

Not only do hospitalizations burden patients’ quality of life, but it can be a financial stressor, too. The economic burden of schizophrenia in the US was estimated to be approximately $343.2 billion in 2019.³

Investigators recognized the need for an alternative treatment option to target the cognitive deficits in schizophrenia.¹ Led by Chuntana Reangsing, PhD, from the school of nursing at Mae Fah Luang University, Chiangrai in Thailand, the team sought to evaluate the effectiveness of mindfulness-based interventions as an alternative treatment option to target psychotic symptoms, global functioning, insight, and mindfulness in patients with schizophrenia spectrum disorders.

Reangsing and colleagues searched 9 electronic databases, including Academic Search Complete, CINAHL, Cochrane, Ovid APA InFo, ProQuest, PubMed, Scopus, Mindfulness Journal, and Web of Science, from inception to March 2024. Investigators reviewed all experimental and quasi-trials in English evaluating the outcomes of mindfulness-based interventions for schizophrenia treatment.

The study included 24 studies (n = 1632), with 796 patients with schizophrenia and 836 controls. More than half of the patients with schizophrenia were male (69%), and the mean age ranged from 24.4 to 59.5 years.

Mindfulness-based interventions reduced psychotic symptoms (95% confidence interval [CI], 0.04 – 1.36) and increased global functioning (95% CI, 0.50 – 2.05), insight (95% CI, 0.88 – 1.55), and mindfulness (95% CI, 0.15 – 0.97), compared with controls.

The subgroup analysis revealed that as the mean age of patients with schizophrenia increased by 1 year, psychotic symptoms worsened (slope = -0.071; P = .016). However, for every day participants increased their mindfulness-based intervention, investigators saw improvement in psychotic symptoms (slope = 0.012; P = .033), functioning (slope = 0.013; P = .017), and insight (slope = 0.001; P = .043).

Additionally, participants who received mindfulness-based interventions in a mixed format, both individually and with a group, had better insight improvement than those who only received the intervention individually. Furthermore, patients who had a home assignment with their mindfulness-based intervention had more improvement in insight than those without a home assignment.

Other than the addition of home assignments, a long mindfulness-based intervention length, more sessions per week, and using intention-to-treat and blinded collectors improved the effectiveness of this treatment.

Investigators noted that most participants in the meta-analysis were in the residual phase of schizophrenia, rather than the prodromal and active phases, so mindfulness-based interventions could be less effective for patients in other phases of schizophrenia.

“Thus, clinicians and health providers might use them as an alternative complementary treatment to improve psychotic symptoms, patients’ functioning, insight, and mindfulness in patients with [schizophrenia spectrum disorders],” investigators wrote.

References

1. ^{Reangsing C, Wongsuraprakit S, Punsuwun S, Oerther S. Effects of mindfulness-based interventions (MBIs) on psychotic symptoms and psychological outcomes in patients with schizophrenia spectrum disorders: A systematic review and meta-analysis. Psychiatry Res. 2024 Nov 18;342:116272. doi: 10.1016/j.psychres.2024.116272. Epub ahead of print. PMID: 39577340.}
2. ^{Correll CU, Xiang P, Sarikonda K, Bhagvandas N, Gitlin M. The Economic Impact of Cognitive Impairment and Negative Symptoms in Schizophrenia: A Targeted Literature Review With a Focus on Outcomes Relevant to Health Care Decision-Makers in the United States. J Clin Psychiatry. 2024 Aug 21;85(3):24r15316. doi: 10.4088/JCP.24r15316. PMID: 39196884.}
3. ^{Kadakia A, Catillon M, Fan Q, Williams GR, Marden JR, Anderson A, Kirson N, Dembek C. The Economic Burden of Schizophrenia in the United States. J Clin Psychiatry. 2022 Oct 10;83(6):22m14458. doi: 10.4088/JCP.22m14458. PMID: 36244006.}